I was hoping to get some feedback from the men who have had a prostatectomy, whether or not they wished that they had chosen one of the forms of radiation instead as their first form of treatment.

Last Monday my husband had his doctor's appointment to go over the second opinion on his biopsy. Second opinion concurred with the firs report: 4 of the 12 cores positive for cancer. I also noticed in the report from John Hopkins that a fifth core is high grade PIN.

My husband's doctor said that he should make a decision within 6 months on what course of treatment he wants to pursue. Some of the members who responded to my post about a doctor in Orlando suggested that since he has a gleason 6 he should take his time, explore all of his options and be sure to see a radiologist. Right now we have a stronger leaning toward surgery, but feel that we should at least see a radiologist and hear what he has to say. Also, has anyone heard whether radiation can potentially cause tumors down the line - say 20 years? Since my husband is 49 his doctor said that that is a possibility with radiation and a drawback.

Surgery for me was the best chance for a cure,with SRT coming soon. My Psa was real high 49.8 with a Gleason of 3+4=7. That turned out to be 4+3=7.Every minute you fish or ride,adds an hour to your life!

Since I had radiation to being with, I obviously cannot answer your primary question. But I will make the following comments:

1. We had a thread on this very issue during the past week. The general conclusion, with which I agree, is that few if any patients will express buyer's remorse...sorta like being in love with a car after you buy it.

2. If you are interested in treatment comparison, might I invite you to read something I posted earlier today on the thread by new member SL. My post received the David (Purgatory) seal of approval which in all seriousness I appreciated.

3. There was a thread here the other day (now on page 4) that referenced an article on secondary cancers from radiation. Cutting thru all of the posts on the thread, the point of the article was that the overall risk of secondary cancer from radiation is less than 1 in 1000....and that the small risks was worth the benefit of the treatment. Risks of dying during surgery have been quoted as greater. But, personally, I would not seriously consider the small risks/events at the edge of the curve. I suggest you focus on the big three...cure, continence and sex.

4. One poster on this thread states that surgery has better results beyond ten years. That is not a proven fact. There are no random controlled studies comparing the effectiveness of surgery vs. radiation. There ARE a number of 15+ year studies done independently that show approximately equal effectiveness.

5. I think I mentioned this on your other thread but please consider a short drive to Sarasota. Dattoli is one of the best at radiation and he will certainly give you the perspective to make an educated decision.

ExFish,The only people that would regret their primary treatment are those that have suffered severe side effects from that treatment and even then it is difficult to admit to themselves they made a wrong choice.The question you posed will not get you the answer you are looking for.The basic facts that Tud has pointed out is that for low risk cancer all treatment options have the same end result in regards to cure. All treatments have very different side affects, both short and long term. A lt also depends on your personality. Some are determined to have the cancer out at all costs and others are OK with the knowledge that the cancer is killed and won't do any futher harm. Surgery cuts the cancer out, while radiation kills it.You would be much better off to focus on the side effects of the treatment options as this is where the differences are. It is generally accepted that the side affects of radiation are generally less than those of surgery. This doesn't mean that in some cases the side affects of either treatment cannot be severe in a minority of cases,As Tud suggested, get an opinion from a noted surgeon in your area and also get one from Dattoli. Have a list of questions to ask each one then go with the treatment you are most comfortable with; you only get to do this one time in your life and the decision should be made with careful consideration of all the options and side effects.JohnT65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

dear ex-fish:I have no regrets at all - gleason 7 - stage 3a - with a bunch of little tumours on one side and a main one (with a hard mass) right at the edge on the other.

It all depends on where the PCa tumours are in the prostate - the biopsy is like a buckshot approach at times - what they saw on the initial MRI (to pinpoint where to take the samples) - what the needle samples find ... sometimes the pathology report changes after surgery-

You may find that the surgery docs go after surgery and the radiation docs go after radiation - (they promote what they do best)

The best decision is what you ( you and your husband) feel comfortable with - getting the best diagnosis - the best treatment - the best doctor and the best hospital...

- we are very glad you are here to share your journey - all the best.hugs,BRONSON

Hmm, I'm interested in the above post by John T that the side effects of radiation are less than with surgery. I thought that the side affects were pretty similiar. Just that the incontinence & ED issues are seen at the beginning with surgery, but appear later after radiation. What other side affects might I be forgetting?

Also, we live at least 2 1/2 hours from Dr. Dattoli in Sarasota. Although that's not a problem to go to him for a consultation, it would not be possible to drive there everyday for the radiation. Is he simply the best one to discuss radiation with and then pursue a radiation doctor closer to home?

I'm about one month out on my prostectomy. I hate the way I feel. I go through 3-4 pads a day and sleep in a diaper at night. By morning it's soaking wet. If I sit perfectly still on the couch there is pretty good bladder control, however when I pick up something or go down the steps the leakage begins. I am so frustrated with the constant flow that I can't do anything without wetting myself. In regard to sex, might as well forget about it. I can get about a 50% woody but the climax (feeling) isn't worth the effort. It just plain does not feel all that great.

Viperguy - - you are too hard on yourself - it takes time to heal up and have your body start working towards your new "normal".

-it takes about 14 weeks for some to have their continence to return after surgery - I started to get control of the situation 16 weeks after surgery - -keep up with your kegel exercises - my doctor had me do - 20 reps (pelvic thrusts) 5 times a day - -ED is not a main problem for me - it responds ( not like before ) with a little help.

-I am sorry you fell that you hate your life - the side effects and the time for recovery should have been discussed prior to surgery.

P.S. also, it is common for a 6 week buffer time after surgery - no lifting of anything more than 10# - and minimum stairs and inclines - a flat treadmill would help keep the metabolism up and help with centre-focus excercise ( pilates stuff) - but avoid inclines and pushing yourself too early - you can tire out the muscles as they heal which can make you leak more..

Hi ex fishsorry to hear about your predicament.I am same age as you hubby well nearly celebrated my 50th with friends racing to the loo half way thru every beer!I was gleason 6 at start but that got upgraded (not sure if stats will show up?) I got 2 opinions both said surgery for me as such high volume of PC and can have second go at radiation if needed, not sure if I'll need it yet. I'm 4 weeks post robotic surgery and not doing to bad, water works are getting better dry at night 2 pads a day, as for ED not much happening there but early days, I had approx 50% of L & R nerve bundle removed again because of volume and location of tumors so will be a miracle if it gets back to normal. I pushed to be done asap and luckily I did as PC was out of prostate capsule and on it's merry way. Post op pathology showed tumors everywhere so biopsies are really a bit of a hit and miss at best. My advice is to find a doctor with good reputation who is very good at what ever he does and you feel comfortable with him/her. Most importantly tell hubby be happy no one likes being around a grumble bum. Good on you for being here, hubby will need all your support and then some, no matter what treatment you choose, good luck and best wishes.age 49, dx 21-01-2011 PSA 5.612 cores all positive >80% in some, Gleason 3+3=6, T2BRALP 10-03-2011, post OP pathology, Gleason 3+4=7 and 1% 5+4=9Prostate 50g, 48mmx40mmx40mm, largest tumor 48mmx34mmx24mm, extensive PIN also present, EPE left apex .2mm, perineural invasion, clear margins closest was .7mm, lymph nodes not checked.path stage pT3A Nx Mx R0post OP PSA ? 11/5/2011

2nd wish, that i could have qualified for Seed Radiation, I had researched heavily on it on advanced, but in the end, in my situation it was not advised, not ever by a radiation oncologist

since both my surgery and my salvage radiation has failed to stop the cancel, the entire subject of choice is mute with me, and i have suffered the full spectrum of complications from both treatment methods

I wouldn't change my mind either. At this point my wife and I are having a lot of fun complying with the doctors orders to use it or lose it. Things may change but for now I'm pretty happy with my choices.age 57 2/2010PSA Feb 8.2biopsy 2/2010 - 2 of 8 left & 2 of 8 right positive, Gleason 3+4=7attended support group - advised to get a second opinionsecond opinion on pathology from Johns Hopkins 4+4=8PSA 15 4/2010 5 weeks IMRT 4/2010-6/2010 at Copley Hospital in Aurora, IL91 palladium 103 seeds 7/2010 at Chicago Prostate Center, Westmont, ILPSA Oct 3.97, Dec 2.78, 3/9/11 2.42

Ex Fish.Generally accepted risk of side affects from top institutions:Patients older than 65 or treated by inexperienced doctors will have greater risks. These are long term side affects; not the short term ones that every treatment has.Surgery: Impotance 50%, Incontinence, 8%; Strictures, 5%Seeds: Impotance 35%; Incontinence 0%; Urethritus, 10%, strictures 1%, proctitis 1%IMRT: Impotance 35%, Incontinence, 0%, Urethritis, 2% proctitis 2-4%

Personaly I would get an opinion from Dattoli as they have sofisticated imaging that can do a much better job staging than local institutions. They also have much more experience in PC. You can get your treatment locally, but any treatment, surgery, seeds or radiation the doctor must have at least 250 under his belt.

JT65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

I'm a seed guy, and the primary reason that I am is because it was my understanding that seeds gave me an equally good chance of beating the cancer with fewer side effects. Nothing that I have experienced has suggested otherwise. I would suggest that anyone who 'qualifies' explore brachytherapy. I never gave any thought to secondary treatment. My goal was to get the best treatment available first time around, and I firmly believe that I did.

I missed 2 days of work, and one week at the gym. PSA went from 6.1 (October, 2010 to 0.24 January, 2011). No incontinence, no ED. I know dozens of guys who have had surgery: I would not trade places with any of them. Just my .02.

This is not question that can be answered aside from the individual situation. I had surgery, and would do it again. However, that's because I had high volume Gleason 7, and even the radiologist recommended surgery. If I had been Gleason 6 I would have gone seeds, and still would. Bottom line, what treatment will give the best odds for a cure given the specific patient?Age: 66Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6Biopsy 8 of 12 positive, Gleason 3+4, T2aDaVinci August 2009, pathology Gleason 4+3, neg margins, T2c Post-surgery PSA one year of zeros.Continent right away.Viagra and other pills only gave me headacheTrimix working great!

I was 50 when I chose Surgery = 10 years ago. Some of side affects weren't fun ED and incontinence but the position of the cancer was the problem not the surgery.

Everyone is different, do not know your husbands age but surgery gives post option treatments if something turns south, such as radiation, chemo etc.

You also have to weigh you husbands family with prostrate cancer. Is it something prevalent which has been terminal. In my family, I had 3 uncles who were terminal due to PC and at my age or a little older

Good Luck with your decision, it is something which will be life changing either way.

I wish I had gone the seed route. My doctor was so down on seeds (a surgeon go figure) and stated "They don't work, i have too many patients that have come to me because seeds failed". Can't shut the gate after the horse is out. The surgery wasn't all that bad but I don't like waking up in the morning to a soaked diaper. I've had so many bad things happen in the last 45 days it's almost unbearable:

1. 02/22/11 best friend since Jr. High died in car while I was taking him to the hospital for blood transfusion

2. 03/03/11 had radical Prostectomy (now pissing my life away)

3. 03/25/11 lost my job in a nationwide downsizing and forced to retire at 50% of current income

I had surgery. My second choice would have been Proton therapy, but I was too far advanced. I was told by the surgeon that if I had radiation prior to surgery it makes any follow up surgery very difficult. Now I am finishing 39 radiation therapy treatments. Not because my PSA was rising, it was undetectable, but because my surgeon and radiation oncologist (both of whom I trust without reservation) suggested it based on a gut feeling.

Someone in this post may have mentioned the surgery - radiation correlation. If not it may be a good question for your medical care professionals.

Think things over I did. Even though I have a tendency to analyze till I paralyze I feel I made the best decision. Only time will tell.

I've done well with the side effects and I got an early start on attacking an advanced case. The data I find supports my actions as well for a case like mine.

It's important to note that there is not a one stop way of treating anybody. Tailoring a protocol that suits you requires some education as to why you do things. i always tell new patients to slow down and consider as much information as possible. Some guys need a customized approach and some are good with any approach.

I would like to add an exception to John T's post. The statistics do not apply to everybody. I am a good example of being treated with surgery, radiation and hormonal therapies and yet I don't have the long term stuff that was written in that post. My biggest fear is the radiation from this point out. Well of course the cancer is my biggest fear but you get my point. Long term side effects are rare with the radiation but they tend to be more extreme than advertised and there is little long term data to look at. Especially when IMRT has not been around in the long term numbers I want to reach.

Just about eleven months ago, I had the seeds implanted and have yet to regret my choice. After reading so many blasted "possible" side effects with surgery, I jumped at the opportunity for Brachytherapy. Of course having my 75th birthday this coming December did also have something to do with my choice of seeds. No regrets from this Old Codger.

My surgeon wouldn't operate. He assessed my probability as having some escape at more than 30% and he won't operate at that point. He said "why put you through the surgery and risks if I think you have a moderate chance of needing radiation and taking on those risks".

He recommended, and after much research I accepted, High Dose Radiation brachytherapy. This form does not leave the seeds in and has lower side effects than seeds and better conformity of the dose to the tumour. I suggest you check it out.

A great information website is Dr Jeffrey Demanes, head of radiology at UCLA and the pioneer in HDR at www.cetmc.com. My doctors in Atlanta have done more than 1,000 of these and I am extremely happy.

My brother's brother-in-law had surgery 8 years ago and he is pleased that he only uses two pads a day at age 58. That is a side effect that I am happy not to have. He has also had radiation following the surgery. His urologist never even mentioned brachytherapy....not his urologist any more.PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.Eligard shot and daily Jalyn started on 10-7-2010.IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.PSA